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The most effective way to treat and cure genitourinary cancers is through a multidisciplinary approach. Our staff of urologists, pathologists, radiation oncologists and medical oncologists can provide the best possible estimate as to how aggressive the cancer is and what all of the potential management options are.
Men newly diagnosed with prostate cancer that have not spread face a very complex condition where multiple decisions need to be made.
The first key issue is to characterize the man's individual cancer as to how aggressive it appears to be. Some of the key characteristics that have to be determined include: how many of the biopsied pieces contained cancer (for example, one biopsy piece on one side of the prostate or biopsy pieces from both sides of the prostate); how well-organized does the cancer appear under the microscope (the Gleason primary and secondary grade resulting in a "Gleason Score," when the two number grades are added together); how large is the prostate; is there any suggestion that the cancer has spread through the lining (capsule) of the prostate; what is the total blood (serum) prostate specific antigen (PSA) level and how rapidly did the PSA level change over time prior to the positive biopsy; and, most importantly, how healthy is a man and what is his anticipated remaining life span.
Only when this information is known can a man consider the first big decision: "Do I need to treat this prostate cancer or can it be watched?"
If a man chooses the latter option, he should enroll into a surveillance clinic (see below). If he wants to consider treatment, he should be evaluated by both a radiation oncologist (e.g. Dr. Dougherty), as well as a surgeon (e.g. his urologist or Dr. Sokoloff).
After those discussions, it is useful to visit with a medical oncologist (Dr. Ahmann, Dr. Singh, or Dr. Elquza) to discuss how most men go about the process of deciding which option of treatment is best for them, as well as to discuss how surveillance is done. Men enrolled in our New Diagnosed, Non-Metastatic Prostate Cancer Clinic will see a Urologist, a Radiation Oncologist and a Medical Oncologist within one week. Once a decision has been reached, the patient will have arrangements made to initiate his management approach.
This clinic is jointly directed by Drs. Sokoloff (urologist), Dougherty (radiation oncology) and Ahmann (medical oncology).
If a man with newly diagnosed, non-metastatic prostate cancer chooses not to be treated, he should consider enrolling in our Surveillance Clinic.
Choosing to not initially be treated does not mean ignoring the disease. The concept of surveillance is to carefully watch the cancer with every three-month clinic visit to assess potential symptoms, to re-examine the prostate, monitoring blood work (most critically a serum PSA level), and, at least after the first and second year of surveillance, to rebiopsy the prostate.
Men who demonstrate a worrisome change in any of these parameters will be counseled as to whether or not they now should consider initiating therapy or to continue to be carefully watched. A large trial being done in Canada indicates that this management approach can be a very good one if a man has a fairly small amount of an unaggressive-appearing prostate cancer. This clinic is directed by Dr. Ahmann.
As of 2012, screening for prostate cancer remains a controversial issue. The physicians making up the genitourinary cancer team at the University of Arizona Cancer Center are strong advocates of establishing in an individual man his projected risk of developing prostate cancer and of screening all healthy men over the age of 50 with at least a life expectancy of 10 years with a digital rectal examination and serum PSA level on a regular basis.
Enrolling into this clinic permits a man without prostate cancer to have his risk of getting the disease estimated and will lead to a man being routinely screened if his risk of getting clinically significant prostate cancer justifies it. This clinic is directed by Dr. Ahmann.
Advanced Prostate Cancer Clinic
In 2012, approximately 70,000 men in the United States will either be initially diagnosed with incurable prostate cancer or will have evidence that they have failed treatment with either surgery or radiotherapy.
The goal of therapy of men in this situation is to control the disease as much as possible for as long as possible with as little adverse effect of treatments as possible. Of these 70,000 men, current statistics indicate that, with a good management approach, more than half will live out their full natural lives and pass on from medical illness other than prostate cancer.
Just as in men found with early prostate cancer, men with advanced cancer can have disease courses that are highly variable. The best treatment strategy for each man must be based on how much prostate cancer a man has, where the cancer is located in the body, how rapidly the disease is progressing and whether or not the individual is having symptoms from the disease.
Fortunately, compared to 15 years ago, there are many treatments available to help men live with the disease as well as possible for as long as possible. The treatment approach must be based on the man’s individual situation with his unique disease. Many times, supportive treatment is required from all three medical specialties. This clinic is directed by Dr. Ahmann and Dr. Singh.
The treatments for prostate cancer, as well as the disease itself, can result in a number of symptomatic complications, such as impotence (impaired ability to have penile erections) and urine leakage. There are many potential interventions to try to help and man and his partner to be palliated for impotence. Similarly, men who have significant urine leakage also have a number of palliative options to consider.
The treatment of kidney cancer centers around the cancer’s stage (how advanced the cancer is). For kidney cancer, the initial treatment intervention is surgery, unless the disease is too far advanced to be helped by surgery. For those men and women with kidney cancer that cannot be cured with surgery, a number of new treatments have emerged in the last five years with antibodies and drugs that block a cancer’s growth pathways. These treatments are leading to improved outcomes in these patients. This clinic is directed by Dr. Hersh and Dr. Singh.
Bladder cancer is usually primarily managed by urologists, as urologist must examine the lining of the bladder and obtaining specimens from the upper drainage tubes (the ureters) and the bladder to examine under a microscope.
Urologists are the key members of the team managing men and women with bladder cancer. Urologists also using their viewing instruments can remove small, superficial bladder cancers. They also direct the infusion of chemicals into the bladder (intravesicular therapy), which lowers the risk of superficial cancers coming back.
Unfortunately, bladder cancers in some men and women grow deeply into the wall of the bladder, and removal of the entire bladder surgically by a urologist needs to be considered. In such patients, medical oncologists may be asked to administer chemotherapy prior to the surgical procedure. If a man or woman’s bladder cancer cannot be cured, management is primarily directed by medical oncologists in conjunction with the urologists. This clinic is directed by Dr. Walker and Dr. Singh.